New pap smear guidelines are troubling

Change in the recommended frequency of tests disturbs one young patient.

The Canadian Medical Association has updated its guidelines regarding pap smear tests.

By:Sara Ostrowska Published on Sun Feb 10 2013

A couple of months ago, I went to my doctor for a pap smear. I dreaded this appointment. Everyone does. However, after the initial question period, she tells me that I no longer need to come in every year for paps and that I in fact did not need to proceed with this particular scheduled one.

She explains to me that if I had a normal result last time I only need to come in every three years, as per new pap practices. I tell her that I wanted to go through the pap because my aunt and my mom have a history of abnormal cells that have almost led to cancer. She tells me that she understands but that the risk is low at my age and reiterates that I’ve never had an abnormal test, but that if I wanted to go through the pap, she will still do it.

She then asks me to remove my clothes and put on the paper examining gown while she steps out for a moment. I awkwardly change and wait for her to return. I hope she doesn’t come back, but she does. She asks me to put my legs up and prepares her medical instruments.

There I was, the paper bag princess, sitting on the cold examination room table, with my legs up in stirrups. All I could think was, “Ew. I hate this.”

I not only consented to this entire horrible experience, but I insisted upon it, despite her assurance that I did not need to go through with it. I didn’t need an abnormal test result to feel reassured, but an abnormal test result is what I got.

So what’s up with this new pap practice? In a report published last month, the Canadian Medical Association updated its guidelines regarding pap smear tests for the first time since 1994.

The report says that the decreased incidences of cervical cancer and its associated deaths are due to pap smears, but that “early and frequent (often annual) cervical screening is unnecessary, [as] other countries have achieved similar outcomes with less frequent testing and starting screening at older ages.”

An alarming part of the report states that the “likelihood of abnormal pap test results is highest for young women,” but that “the proportion of abnormal results that represent serious abnormalities is greater among older women.”

Nonetheless, the report recommends that women aged 20 to 24 years forego routine screening for cervical cancer and that women aged 25 to 29 years go for routine screening every three years. These recommendations are considered “weak recommendations” based on “moderate-quality evidence.”

Why is there a recommendation given to women aged 20-24 years if it’s described as weak and only backed by moderate-quality evidence? Why was I almost persuaded out of having my pap smear, especially when my family has a history of abnormal cells? Aren’t paps also useful for the detection of STIs and STDs? Is this not a period of sexual experimentation, promiscuity and learning?

Although in the report they recommend that clinicians discuss the harms and benefits of screening to help women make their own informed decisions, many doctors are not apt to explain everything and many people tend to just follow what they’re told.

I’m sure many of you would hear that you didn’t need to have a pap smear every year and jump for joy (and reasonably so, it’s invasive and sucky). That’s OK! However, you should be given all the relevant information before you’re expected to make this sort of judgment. You should be given the option to make an informed choice.

I will continue to have annual pap smear tests because I think it’s right and safe for me, and because, personally, I think that this is just another form of cutting costs and saving time for more immediate and important matters.

So please give me my pap, doc. Not because I like it, but because I want it.

Sara Ostrowska is a student at Trent University. A longer version of this article appeared in the Trent student newspaper Arthur.

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